Autologous Fat Injection for Soft Tissue Augmentation in the Face: A Safe Procedure?

Autologous fat injection for soft tissue augmentation in the face is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction following fat injections into the face. Acute visual loss after injection of various substances into the face is a well-known complication of such interventions. We report two further patients who suffered from ocular and cerebral embolism after fat injections into the face. For the intravasation of fat particles there are three preconditions: well-vascularized tissue, fragmentation of parenchyma, and, especially, a local increase in pressure in the affected tissue. Fat injections into the face lead to an acute local increase in pressure in highly vascularized tissue. We assume that fragments of fatty tissue reach ocular and cerebral arteries by reversed flow through branches of the carotid arteries after they are introduced into facial vessels. The manifestation of fat embolism appears either immediately after the fat injection or after a latency period. Fat embolism can remain subclinical and may not be recognized, or the clinical features may be misinterpreted. To minimize the risk of such a major complication, fat injections should be performed slowly, with the lowest possible force. One should avoid fat injections into pretraumatized soft tissue, for example, after rhytidectomy, because the risk of intravasation of fat particles may be higher. Metabolic disturbances such as hyperlipidemia may also contribute to the clinical manifestation of fat embolism. Routine funduscopic examinations after fat injections into the face could help to provide data for future estimation of the patient's general risk.     

An Assay to Measure Angiogenesis in Human Fat Tissue

Background Inhibition of angiogenesis reverses rodent obesity. A validated assay in human fat tissue is needed to study the role of angiogenesis in human obesity. Methods Human fat tissue fragments from surgery were placed in 96-well plates, embedded in fibrin thrombin clot and overlaid with cell culture media containing 20% fetal bovine serum. After 15 days, the clots were examined by histology and electron microscopy. The effect of taxol, cobalt chloride and a heparin-steroid combination was tested in the fat tissue assay and compared to the validated human placental vein angiogenesis model (HPVAM). Results Blood vessels initiated growth and elongated from the fat tissue fragments over 15 days. Presence of blood vessels was confirmed with histology and electron microscopy. Taxol at 10⁻⁶ and 10⁻⁷ M completely inhibited angiogenesis, while Taxol 10⁻⁸ and 10⁻⁹ M and the heparin-steroid partially inhibited angiogenesis.The response to taxol and heparin-steroid was similar to that of the HPVAM, a validated angiogenesis assay. Cobalt chloride, a stimulator of vascular endothelial growth factor (VEGF) stimulated angiogenesis initiation at 10−9 M in fat tissue and the HPVAM, but at 10⁻¹⁰ M blood vessel growth was stimulated only in the fat assay. Conclusion This angiogenesis assay based on human fat tissue uses three-dimensionally intact human tissue. The vessels are derived from quiescient vessels within the fat. These properties allow the angiogenic switch to be evaluated in an in vitro setting. The angiogenic response of fat tissue is not identical to placental tissue. This assay allows exploration of angiogenesis in fat tissue.     

Fat injections for the correction of facial lipodistrophies: A preliminary report

We present our experience with fat injections in the treatment of two cases of facial lipodistrophies. The surgical technique as well as the followup of the two clinical cases are presented in order to evaluate the long post-operative results. Among the different techniques used by us for correcting the soft tissues of the facial contour, this has been by far the simpliest and easiest. We need longer followups and more clinical cases in order to point out some definite conclusions, however. Nevertheless, it is our impression in this preliminary report that this technique could have a place in the treatment of problems related to the soft tissues of the facial contour.     

Adipose tissue and lipid droplet embolism following periurethral injection of autologous fat: Case report and review of the literature

The authors present a case of a death associated with pulmonary adipose tissue and lipid droplet embolism following autologous fat harvesting, periurethral injection and videocystourethroscopy for the treatment of recurrent genuine stress incontinence.     

An Unusual Case of Histiocytosis X in the Spine

A case of spontaneously healing histiocytosis X followed over 9 years is presented. The lesion was located in the cervical and dorsal spine and had unusual radiological features such as soft tissue swelling, involvement of the pedicles and recovery with fusion between adjacent vertebra.     

Fat transplantation for soft tissue augmentation in the lower limbs

Attempts at fat transplantation in humans began as early as 1893 with Neuber [1] and came to the fore again with the introduction of liposuction. In his 1988 paper, titled ``Present Results of Fat Injections,' Illouz [2] concluded that permanent results were achieved in only 20 to 30% of cases. Numerous other authors also reported poor outcomes. The uniform conclusion of almost all the authors was that the outcome was the result of the common method they followed, that is, injecting fat subcutaneously. However, the poor perfusion of the subcutaneous tissue does not appear to be adequate for the timely revascularization of adipocytes. Around 1983 Jose Guerrerosantos [3,4] successfully injected fat intramuscularly in guinea pigs. Subsequent removal and histological examination of the grafts demonstrated revascularization and almost-complete survival of adipocytes, presumably due to the rich perfusion of the muscle.     

Fat extravasation due to unreamed and experimentally reamed intramedullary nailing of the sheep femur

Aim

To compare systemic fat extravasation in unreamed and experimentally reamed nailing.

Methods

An osteotomy was created in the proximal third of the femoral shaft in 16 sheep, and intramedullary pressure increase and fat extravasation were monitored for the two nailing techniques.

Results

The highest intramedullary pressures, median 2700 mmHg, and highest percentages of fat extravasation, peaking at almost 90% of fat, were found for the unreamed nailing technique. The values for the reamed group were significantly lower.

Conclusions

The extravasation of intramedullary fat can be attributed to the great increase in intramedullary pressure that occurs during unreamed nailing. Correctly performed intramedullary reaming with the new reaming system produces lower pressures and much less systemic fat extravasation, reducing the risk for fat embolism.     

颗粒脂肪移植治疗上睑凹陷的临床效果

目的 探究对上睑凹陷患者应用颗粒脂肪移植治疗的临床效果。方法 选取2021年7月-2022年7月我院收治的82例上睑凹陷患者为研究对象,采用随机数字表法分为参照组和探究组,每组41例。参照组实施重睑切开联合块状脂肪移植治疗,探究组实施颗粒脂肪移植治疗,比较两组临床疗效及治疗满意度。结果 探究组治疗总有效率为100.00%,高于参照组的90.24%（P＜0.05）;探究组治疗满意度为97.56%,高于参照组的80.49%（P＜0.05）。结论 针对上睑凹陷患者采用颗粒脂肪移植治疗的临床效果良好,可有效改善患者的上睑凹陷情况,有利于提高治疗满意度。     

Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation,Anatomic Study in Fresh Cadavers

Introduction: Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. Methods: A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. Results: We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. Conclusions: The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.     

Correction for the Iatrogenic Form of Banana Fold and Sensuous Triangle Deformity

The “banana fold,” or the infragluteal fold, is a fat deposit on the posterior thigh near the gluteal crease and parallel to it. The “sensuous triangle” is found at the junction of the lateral buttocks, the lateral thigh, and the posterior thigh. The iatrogenic forms of banana fold and sensuous triangle deformity are produced by excessive liposuction. The authors’ experience using autologous fat transplantation to treat tissue defects led them to use this technique for correcting iatrogenic forms of banana fold and sensuous triangle deformity. The simplicity of the procedure, the low incidence of complications, and the high satisfaction rate makes autologous fat transplantation an attractive option for correcting iatrogenic complications of liposuction.     

Relationship of Total Body Fat Mass to Bone Area in New Zealand Five-Year-Olds

Fat mass was recently shown to be a positive determinant of bone mass and size independently of lean mass in a birth cohort of British 9-year-olds. The present study was undertaken to investigate whether similar relationships are evident in younger, preschool children. Height and weight were measured, and a total-body dual-energy X-ray absorptiometric scan was performed on 194 preschool New Zealand children (81 girls, 113 boys) participating in the Dunedin birth cohort Family, Lifestyle, Activity, Movement, and Eating (FLAME) study close to their fifth birthday. Relationships of total-body fat mass and lean mass to total-body-less-head (TBLH) bone area and TBLH bone mineral content (BMC) were evaluated using linear regression. Girls had higher mean fat mass (3.9 vs. 3.2 kg) and lower lean mass (14.5 vs. 15.2 kg) than boys (P < 0.001), but their heights, weights, and TBLH bone area were similar. Although a given weight of lean tissue was associated with greater increases in TBLH area than a given weight of fat tissue, our results show that fat mass was an independent predictor of TBLH bone area (R ² = 0.79, P < 0.001) and TBLH BMC (R ² = 0.74, P < 0.001) in data adjusted for socioeconomic status, ethnic group, lean mass, and height. We conclude that increased fat mass is associated with outward expansion of the TBLH skeletal envelope (wider bones) independently of height and lean mass in very young children.     

实验性脂肪栓塞脑组织中氧自由基的变化

本文通过复制家兔脂肪栓塞模型,应用电子自旋共振(ESR)波谱仪检测脑组织中氧自由基信号强度,与对照组比较.发现实验组在脂肪栓塞后氧自由基信号显著增强(P<0.025),提示:脂肪栓塞后肺的缺血、炎症变化可以产生大量氧自由基,继而加重脑组织损伤.     

An Unusual Case of Renal Failure Due to Solitary Plasmacytoma: Parenchymal Invasion of the Kidney

Abstract

Solitary extramedullary plasmacytoma (EMP) is a rare plasma cell disorder mostly involving the upper airway; however, retroperitoneal infiltration is very rare. Kidney injury associated with EMP is exceptionally rare with only anecdotal reports. Herein we report a case of retroperitoneal EMP causing renal failure by the way of direct renal parenchymal infiltration. Renal parenchymal invasion should be considered in aggressive and refractory plasma cell dyscrasias with unexplained renal failure.     

自体脂肪颗粒移植在修复面部整形术后局部凹陷并发症中的应用

目的 探讨自体脂肪颗粒移植对面部整形术后常见的局部凹陷并发症进行修复的方法和临床效果.方法 选择腹部、大腿部等作为脂肪供区,在局部肿胀麻醉伴或不伴静脉麻醉下行脂肪抽吸术,将抽吸获得的脂肪混悬液低速离心纯化后按需要均匀地注射移植于面部整形术后局部凹陷的部位.根据预后情况可多次注射.结果 自2007年3月至2012年9月,共采用此方法对28例患者进行治疗,术后修复部位充盈、自然,效果满意.结论 自体脂肪颗粒移植是进行面部整形术后修复局部凹陷的有效方法,值得临床推广应用.